The buccal fat pad (BFP) is a deep-seated structure in the cheek that significantly influences facial contours. Unlike the superficial layer of fat beneath the skin, the BFP is a distinct anatomical structure whose fate with age is a complex topic in facial aging research. Understanding the behavior of this unique fat compartment is central to grasping why the face changes shape over a lifetime and how modern aesthetic procedures address these changes.
The Anatomy of Buccal Fat
The buccal fat pad is an encapsulated mass of adipose tissue situated deep within the cheek, separate from the subcutaneous fat layer. It is positioned between the major muscles of the face, specifically lying lateral to the buccinator muscle and medial to the masseter muscle. This specialized location allows the BFP to function primarily as a gliding pad, reducing friction between the muscles used for chewing and facial expression. In infants, the BFP is particularly voluminous, and its function is to provide structural support to the cheeks, preventing them from collapsing inward during the process of suckling.
Natural Changes in Buccal Fat Over Time
The question of whether the buccal fat pad decreases with age is complicated by two distinct processes: true volume change and positional change. Some quantitative studies using advanced imaging have suggested that the total volume of the BFP does not significantly decrease with age, or may even increase, especially when correlating with a person’s overall body mass index. This finding contrasts with the volume loss observed in other deep and superficial fat compartments of the face. The most agreed-upon change affecting the BFP is gravitational descent, or ptosis, caused by the gradual attenuation of the ligaments and supporting structures. As these structures weaken, the BFP shifts downward and outward, sometimes leading to a visible bulge in the lower part of the cheek, a process often termed pseudoherniation.
How Buccal Fat Influences Facial Appearance
The BFP plays a significant role in defining the transition between the prominent cheekbone and the jawline. In a younger face, the BFP contributes to the smooth, convex fullness of the mid-face, often associated with a youthful “apple cheek” appearance. With age and the descent of the buccal fat pad, this smooth transition is disrupted. The downward shift of the fat contributes to the deepening of the nasolabial fold and can lead to the appearance of a hollow or sunken area just below the cheekbone, while simultaneously creating a bulge lower down near the jowl area. The combined effect of BFP descent and the atrophy of surrounding fat creates shadows and contours that define the aged facial appearance.
Options for Modifying Facial Contours
For individuals seeking to address the perceived fullness of the lower cheek, buccal fat removal (BFR) is often considered. This surgical intervention involves making a small incision inside the mouth to access and remove a portion of the encapsulated buccal fat pad. The goal of BFR is to create a more sculpted, defined cheek hollow and to accentuate the cheekbones, effectively slimming the lower third of the face. Patient selection is important for this procedure, as removing too much volume can lead to an overly gaunt or prematurely aged look later in life. Conversely, for those experiencing the signs of volume loss or hollowing in the mid-cheek, the focus shifts to volume restoration.
Volume Restoration
Non-surgical options include the strategic placement of dermal fillers, typically hyaluronic acid-based, into the deep medial cheek fat compartments. These injectable treatments restore the projection and support that has been lost, counteracting the effects of BFP atrophy and descent. For a more permanent solution, fat grafting uses a patient’s own fat transferred to deficient areas to replenish lost volume and restore a smoother contour.